Abstract:

Objective To develop a comprehensive family integrated care program for very low birth weight infants and to investigate the initial application effect of the program. Methods The family integrated care program for very low birth weight infants was developed using semi-structured interviews，a comprehensive literature review，and an expert consensus. A non-synchronous controlled trial was subsequently carried out. Between January and May 2023，35 participants accompanied by their parents for a minimum of 6 hours daily over a span of at least 3 days，were consecutively selected as an intervention group. Between January and May 2022，35 participants in the control group were treated with routine closed neonatal intensive care unit model. The application effect of the program on the clinical outcomes of very low birth weight infants was assessed，such as weight gain rate during hospitalization，breastfeeding days，incidence of late-onset sepsis，incidence of extrauterine growth restriction at discharge，TIMP level at corrected gestational age of 37 weeks and hospitalization days. Results The authority coefficient of the 8 invited experts specializing in neonatal nursing and nursing management was 0.925. A comprehensive program was developed，consisting of 2 stages—preparation and implementation，and addressing 7 key themes：staff team formation and training，environmental support，assessment，parental training，family-integrated care implementation，peer support，and comprehensive communication. No shedding cases occurred during the application of the program. The outcomes indicated that the intervention group experienced a higher rate of weight gain and more days of breastfeeding compared to the control group，and the incidence of extrauterine growth retardation upon discharge was also lower，with statistically significant differences（all P<0.05）. However，there were no significant differences in other clinical outcomes（all P>0.05）. Conclusion The family integrated care program for very low birth weight infants developed in this study is scientifically grounded，comprehensive，and practical. The implementation of this program can promote the weight gain and breastfeeding among very low birth weight infants，reduce the occurrence of extrauterine growth restriction upon discharge，and does not increase the incidence of late-onset sepsis.

Key words: Infant, Very Low Birth Weight, Family Integrated Care, Intensive Care Units, Neonatal, Pediatric Nursing

摘要：

目的 构建全面、适用于极低出生体重儿的家庭参与式照护方案，并探讨该方案的应用效果。 方法 通过半结构式访谈、文献回顾、专家论证法构建极低出生体重儿家庭参与式照护方案。采用非同期对照试验，便利选取2023年1月—5月上海市某三级甲等儿童专科医院NICU收治的35例极低出生体重儿及其父母作为试验组，采用极低出生体重儿家庭参与式照护方案进行护理，保证父母每天参与照护的时间≥6 h，至少干预3 d。选取2022年1月—5月收治的35例极低出生体重儿及其父母作为对照组，采用NICU常规护理。比较两组住院期间体重增长速度、母乳喂养天数、出院时宫外发育迟缓发生率、晚发型败血症发生率、纠正胎龄37周时婴儿运动能力测试（Test of Infant Motor Performance，TIMP）评分<同胎龄早产儿TIMP评分第25百分位数的比例、住院天数等指标。 结果 邀请8名新生儿临床护理及护理管理专家进行专家论证，其权威系数为0.925。方案终稿包括准备和实施2个阶段，团队组建与培训、环境支持、评估、父母培训、实施家庭参与式照护、同伴支持、充分沟通7个主题。方案应用过程中，无脱落病例。应用结果显示，试验组体重增长速度快于对照组、母乳喂养天数多于对照组、出院时宫外发育迟缓发生率低于对照组，差异具有统计学意义（均P<0.05）。其余指标比较，差异无统计学意义（均P>0.05）。 结论 该研究构建的极低出生体重儿家庭参与式照护方案具有科学性、全面性和可行性。实施该方案可促进患儿体重增长及母乳喂养、降低出院时宫外发育迟缓发生率，且未增加晚发型败血症发生率。

关键词: 婴儿, 极低出生体重, 家庭参与式照护, 重症监护病房, 新生儿, 儿科护理学